St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BSTN SCI INGEVITY MRI LEAD 774259

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66573173
Hospital Revenue Code	275
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BS TRIAL LEAD KIT 50CM

Facility

$1,500.00

Service Code	HCPCS C1778
Hospital Charge Code	40204562
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

BS TRIAL LEAD KIT 50CM

Facility

$1,500.00

Service Code	HCPCS C1778
Hospital Charge Code	40204562
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.66
Rate for Payer: Aetna Government	$550.66
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$862.50
Rate for Payer: EmblemHealth Commercial	$750.00
Rate for Payer: Fidelis Medicare Advantage	$1,575.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$975.00

BTB TIGHTROPE

Facility

$1,520.00

Service Code	HCPCS C1776
Hospital Charge Code	64903682
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,596.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$836.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$912.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$760.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$874.00
Rate for Payer: EmblemHealth Commercial	$760.00
Rate for Payer: Fidelis Medicare Advantage	$1,596.00
Rate for Payer: Group Health Inc Commercial	$760.00
Rate for Payer: Group Health Inc Medicare	$532.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$760.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$988.00

BTB TIGHTROPE

Facility

$1,520.00

Service Code	HCPCS C1776
Hospital Charge Code	64903682
Hospital Revenue Code	278
Min. Negotiated Rate	$760.00
Max. Negotiated Rate	$760.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$760.00

BUCKS EXTENSION

Facility

$69.46

Hospital Charge Code	40200662
Hospital Revenue Code	270
Min. Negotiated Rate	$24.31
Max. Negotiated Rate	$55.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.73
Rate for Payer: Aetna Government	$34.73
Rate for Payer: Brighton Health Commercial	$52.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.23
Rate for Payer: Group Health Inc Commercial	$34.73
Rate for Payer: Group Health Inc Medicare	$24.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.73
Rate for Payer: Hamaspik Choice Inc Medicare	$34.73

BUDESONIDE 0.125 MG/1 ML NEB SOLN

Facility

$5.00

Hospital Charge Code	41641904
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

BUDESONIDE 0.125 MG/1 ML NEB SOLN

Facility

$5.00

Hospital Charge Code	41651904
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

BUDESONIDE 0.25 MG/2ML IN SUSP [28774]

Facility

$4.74

Service Code	HCPCS J7626
Hospital Charge Code	00487960101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.23
Rate for Payer: Group Health Inc Commercial	$2.37
Rate for Payer: Group Health Inc Medicare	$1.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.37
Rate for Payer: Hamaspik Choice Inc Medicare	$2.37
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.08

BUDESONIDE 0.25 MG/2ML IN SUSP [28774]

Facility

$5.23

Service Code	HCPCS J7626
Hospital Charge Code	00186198804
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$4.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.56
Rate for Payer: Group Health Inc Commercial	$2.61
Rate for Payer: Group Health Inc Medicare	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61
Rate for Payer: Hamaspik Choice Inc Medicare	$2.61
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.40

BUDESONIDE 0.25 MG/2ML IN SUSP [28774]

Facility

$4.71

Service Code	HCPCS J7626
Hospital Charge Code	00115168774
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.35
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2.35
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

BUDESONIDE 0.25 MG/2ML IN SUSP [28774]

Facility

$4.71

Service Code	HCPCS J7626
Hospital Charge Code	00093681573
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.35
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2.35
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

BUDESONIDE 0.25 MG/2ML IN SUSP [28774]

Facility

$4.70

Service Code	HCPCS J7626
Hospital Charge Code	00093681555
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.35
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.35
Rate for Payer: Hamaspik Choice Inc Medicare	$2.35
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41642677
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$8.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$8.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.81
Rate for Payer: Group Health Inc Commercial	$6.79
Rate for Payer: Group Health Inc Medicare	$4.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.83

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41642677
Hospital Revenue Code	636
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$6.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41652677
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$8.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$8.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.81
Rate for Payer: Group Health Inc Commercial	$6.79
Rate for Payer: Group Health Inc Medicare	$4.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.83

BUDESONIDE 0.25 MG/2 ML NEB SOLN

Facility

$13.58

Service Code	HCPCS J7626
Hospital Charge Code	41652677
Hospital Revenue Code	636
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$6.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.79
Rate for Payer: Hamaspik Choice Inc Medicare	$6.79

BUDESONIDE 0.5 MG/2ML IN SUSP [28775]

Facility

$5.54

Service Code	HCPCS J7626
Hospital Charge Code	00093681619
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$4.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$4.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.77
Rate for Payer: Group Health Inc Commercial	$2.77
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.60

BUDESONIDE 0.5 MG/2ML IN SUSP [28775]

Facility

$5.54

Service Code	HCPCS J7626
Hospital Charge Code	00093681673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$4.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$4.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.77
Rate for Payer: Group Health Inc Commercial	$2.77
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.60

BUDESONIDE 0.5 MG/2ML IN SUSP [28775]

Facility

$5.54

Service Code	HCPCS J7626
Hospital Charge Code	00093681655
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$4.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$4.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.77
Rate for Payer: Group Health Inc Commercial	$2.77
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.60

BUDESONIDE 0.5 MG/2ML IN SUSP [28775]

Facility

$5.54

Service Code	HCPCS J7626
Hospital Charge Code	00115168974
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$4.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$4.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.77
Rate for Payer: Group Health Inc Commercial	$2.77
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.20
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.28
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.60

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41652918
Hospital Revenue Code	636
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41642918
Hospital Revenue Code	636
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41642918
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$9.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$8.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.40
Rate for Payer: Group Health Inc Commercial	$7.30
Rate for Payer: Group Health Inc Medicare	$5.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.50

BUDESONIDE 0.5 MG/2 ML NEB SOLN

Facility

$14.61

Service Code	HCPCS J7626
Hospital Charge Code	41652918
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$9.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$8.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.40
Rate for Payer: Group Health Inc Commercial	$7.30
Rate for Payer: Group Health Inc Medicare	$5.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.28
Rate for Payer: SOMOS Essential	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.50

Know your out-of-pocket cost for care.

All Charges